When a heart attack strikes, time is of the essence. Intuitively, we all know it: The faster we get help, the better the outcome. Doctors say that “time is muscle,” because the longer a heart attack goes untreated, the more heart muscle dies and is irrevocably lost.
But statistics show that most people don’t receive treatment within the critical 60–90 minutes after a heart attack starts. Emergency departments have worked hard to reduce the time it takes for a person to receive treatment, and local emergency medical services have improved significantly in the past few decades. As it turns out, however, the biggest delay in treatment occurs before the professionals even get involved.
The most common reason for delay in treatment of a heart attack, according the National Heart, Lung, and Blood Institute (NHLBI), is the time it takes the person to seek help. The NHLBI says that median time from onset of symptoms to calling for help ranges from 2 to 6.4 hours.
All people need to be more aware of the symptoms of a heart attack and know how to respond quickly, but it’s even more important for people with diabetes because they have a 2–4 times higher risk of heart attack and other heart disease. They’re more likely to die before reaching the hospital with a first heart attack and more likely to die in the hospital while undergoing a cardiac procedure, and they do less well following a heart attack or an intervention such as surgery. The rate of death for the five years following a heart attack is as high as 50%, or twice that of people without diabetes.
In the general population, heart attack risk is higher in men than in women under 50 years of age. Diabetes erases that difference, causing an increased risk in women with diabetes.
There also are associations with other diabetes complications. For instance, cardiovascular mortality is much higher among people with end-stage kidney disease, as much as fivefold higher in the elderly. The effect apparently begins early: Cardiovascular complications increase as kidney function diminishes.
This increased risk of heart disease applies both to people with Type 1 diabetes and those with Type 2 diabetes. Researchers have found early signs of heart disease even in relatively young people with Type 1 diabetes who had no symptoms.
The mystery of delay
The NHLBI says that there are common factors among people who tend to delay seeking treatment for a heart attack. Factors contributing to increased delay include older age, female gender, and lower socioeconomic status. They also include a history of angina, diabetes, or both.
Why would someone with diabetes delay seeking treatment for a heart attack? Part of the reason seems to be misperceptions about who’s at risk for a heart attack. One survey, published in February 2002 by the American Diabetes Association (ADA) and the American College of Cardiology, reported that half of people with diabetes do not believe they are at higher risk for heart disease. Sixty percent did not feel they were at risk for high blood pressure or high cholesterol, two important cardiovascular risk factors that often accompany diabetes. Half of the people surveyed reported that their physicians had never discussed reducing risk factors such as blood pressure or cholesterol. A third of those who smoked (smoking is a risk factor for heart disease) said they had not been advised to quit.
These findings are consistent with other epidemiologic studies investigating preventive care for people with diabetes. Published reports of prophylactic aspirin therapy use among people with diabetes, for instance, range from 5% to 18%, despite guidelines suggesting that most people with diabetes should be on aspirin therapy.